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Porocarcinoma of the Eyelid Presenting as an Umbilicated Lesion

Charles, Norman C. MD; Kim, Eleanore T. MD

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Ophthalmic Plastic and Reconstructive Surgery: November/December 2021 - Volume 37 - Issue 6 - p e224
doi: 10.1097/IOP.0000000000001956
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A 29-year-old woman presented with a 2.5-mm umbilicated flesh-colored nodule of the right upper eyelid margin that was considered to represent a basal cell carcinoma, keratoacanthoma or molluscum contagiosum (A). Excisional biopsy displayed an intradermal tumor comprised of jaggedly infiltrating cords of cells characterized by enlarged hyperchromatic nuclei and small amounts of eosinophilic cytoplasm (B, C) with ductal differentiation (arrow) (D). Tumor was present on the surgical margins and was cleared by Mohs micrographic surgery. Histologic diagnosis is usually based on morphology but may be confirmed by immunohistochemistry. Immunostains showed characteristic focal reactivity for cytokeratins 19 and 7 (E, F), CD117 (G), and epithelial membrane antigen (H). Ki67 displayed a brisk proliferation rate. No distant metastases were detected by MRI examinations of the face, neck, and lung over 10 months follow-up.

Porocarcinomas are unusual cutaneous tumors developing from eccrine sweat glands. Rarely occurring on the eyelid, the 6 previously reported cases all displayed larger lesions than the current case without distinguishing characteristics. None recurred, compared with lesions elsewhere on the integument showing 20% local recurrence, 20% lymph node involvement, and 10% metastasis to solid organs. The better prognosis for eyelid lesions may reflect earlier detection and smaller size.

© 2021 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.